Affordable Care Act

The Affordable Care Act and Adolescents. Teen Pregnancy Prevention

In 2011, the teen birth rate for ages 15-19 was 31.3 live births per 1,000 population, or 329,797 births. This is the lowest rate since 1991; however, disparities in teen birth rates persist. In 2011, the teen birth rate for Latinos was 49.4 per 1,000, 47.4 per 1,000 for Non-Latino African Americans and 36.2 per 1,000 for American Indian and Ala

The Affordable Care Act and Adolescents. School-Based Health Centers

School-based health centers provide medical care, mental health services, and oral health care and / or preventive services through nearly 2,000 schools nationally. 13 The Affordable Care Act (Section 4101) appropriated funds to school-based health centers to address capital needs. Through this grant program, the Department of Health and Human Se

The Affordable Care Act and Adolescents. Other Relevant Affordable Care Act Initiatives

In addition to coverage and benefit provisions, the Affordable Care Act includes several other provisions aimed at improving health and healthcare access among adolescents. These include funding for school-based health centers, teen pregnancy prevention programs, home visiting programs, a childhood obesity demonstration project, and the expansion

The Affordable Care Act and Adolescents. Essential Health Benefits

For plan or policy years beginning on or after January 1, 2014, non-grandfathered individual and small group market insurance plans must cover benefits in ten categories of services and items included in the definition of essential health benefits (EHBs). The ten categories include: ambulatory patient services; emergency services; hospitalizatio

The Affordable Care Act and Adolescents. Medicaid/ Children’s Health Insurance Program (CHIP)

The Affordable Care Act (Section 2001) requires maintenance of the pre-Affordable Care Act Medicaid and CHIP eligibility levels for children 18 and younger through 2019. In addition, the Affordable Care Act requires all states to provide Medicaid coverage for children ages 6-18 with incomes at or below 133 percent of Federal Poverty Level Guidelin

The Affordable Care Act and Adolescents. Dependent Coverage Expansion

As of September 23, 2010, the Affordable Care Act (adding new Section 2714 to the Public Health Service Act) and its implementing regulations provide that new or renewing plans in the individual and group markets are required to cover dependents ages 25 and younger if they offer dependent coverage. This applies to young adults even if they are mar

The Affordable Care Act and Adolescents. Prohibition of pre-existing conditions denials

An estimated 25 percent of all children between the ages of 12 and 17 have special health care needs. For example, about 11 percent of adolescents 12-17 have Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD) and 10 percent have asthma. 9 The Affordable Care Act (adding new Section 2704 to the Public Health Servic

The Affordable Care Act and Adolescents. Preventive Health Services with No Co-Pay

Health promotion, disease prevention, early intervention, and timely treatment of conditions can improve the health status of adolescents and reduce the incidence of chronic conditions in adulthood. The Affordable Care Act (adding new Section 2713 to the Public Health Service Act) seeks to make prevention affordable by requiring most private hea

The Affordable Care Act and Adolescents. Select Coverage and Benefits Provisions of the Affordable Care Act

The Affordable Care Act includes provisions intended to improve access to health insurance coverage and ensure that such coverage provides essential health benefits for adolescents and young adults. Several of these provisions are already in effect for most plans, including requirements to cover preventive services without cost-sharing, a prohibit

U.S. Department of Health and Human Services: Rate Review Annual Report September 2013. Endnotes

1 § 2794(c) of the Public Health Service Act, as added by § 1003 of the Patient Protection and Affordable Care Act, 42 U.S.C. § 18001 (2010). 2 45 C.F.R. 154.200 3 Beginning in 2014, regulations require states to report all rate increases, even though only increases of 10 percent or more are reviewed for “reasonableness.”

U.S. Department of Health and Human Services: Rate Review Annual Report September 2013. Conclusion

The rate review provisions of the Affordable Care Act are building the foundation for a health insurance marketplace where consumers can make informed choices and insurance companies are held accountable for unreasonable rate increases. Requests for rate changes are now public information, and issuers must provide a justification for requested

U.S. Department of Health and Human Services: Rate Review Annual Report September 2013. Rate Review Grantee Activities

Between 2010 and 2012, 47 states, including the District of Columbia, received Rate Review Grants. States are using Rate Review Grant funds to implement extensive enhancements to their rate review programs and increase publicly-available data. One means of enhancing their programs was to institute rate review authority. Between 2010 and

U.S. Department of Health and Human Services: Rate Review Annual Report September 2013. Individual Market

Approximately 28 percent of all 2012 individual market rate increase requests of 10 percent or more were modified by the issuer or rejected by the state (where the state had such authority). Figure 3

U.S. Department of Health and Human Services: Rate Review Annual Report September 2013. Rate Justification Program

The Affordable Care Act authorizes HHS to focus special attention on rate increase requests that are potentially “unreasonable.” By regulation, HHS has defined requested rate increases of 10 percent or more as the threshold triggering greater scrutiny. 8 Insurance companies requesting such an increase must submit, both to HHS and their sta

U.S. Department of Health and Human Services: Rate Review Annual Report September 2013. Rate Requests for Increases of 10 Percent or More

Regulations implementing the Affordable Care Act also require health issuers that seek a rate increase of 10 percent or more to submit, both to their state insurance regulator and HHS, a justification of the rate increase. 2 The request, justification, and determination of whether the requested increase is unreasonable, are public information p

U.S. Department of Health and Human Services: Rate Review Annual Report September 2013. Rate Review Grants

The Affordable Care Act authorizes the Secretary to award grants to states for the purpose of improving their review of proposed rates in the individual and small group health insurance markets. 1 The law appropriates $250 million for rate review grants for a five year period, fiscal years 2010 through 2014. Each state receiving a grant must

U.S. Department of Health and Human Services: Rate Review Annual Report September 2013. Introduction

This is the second Rate Review Annual Report issued by HHS. The first was issued in September 2012 and was based on data submitted by rate review grantee states from September 2011, when reporting from grantee states began, through July 2012. This Annual Report is based on the data for requested and approved rate increases submitted by grant

U.S. Department of Health and Human Services: Rate Review Annual Report September 2013. Executive Summary

The Affordable Care Act continues to bring transparency and scrutiny to health insurance rate increases. Because of the law, the Department of Health and Human Services (HHS), along with states, is working to hold insurance companies accountable by requiring them to document, submit for review, and publicly justify rate increases of 10 percent

Fifty-Six Percent of the Uninsured Could Pay $100 or Less per Month for Coverage in 2014. Endnotes

1 This number, based on the 2011 American Community Survey (ACS), is the estimate of Americans who are citizens or legal residents under the age of 65 and therefore eligible for coverage either in the Marketplace or through Medicaid. Some of these were eligible for Medicaid or CHIP coverage prior to 2014 but were not enrolled. 2 Totals do no

Fifty-Six Percent of the Uninsured Could Pay $100 or Less per Month for Coverage in 2014. Methodology

This analysis is based on information about household composition and income taken from the 2011 American Community Survey (ACS) Public Use Microdata Sample. To calculate the premium tax credit, the Affordable Care Act specifies that a family with a particular income will pay a fixed amount for the second lowest-cost silver plan available in the

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